1 Introduction
This study describes a replicable process for coproducing a theory of ‘thriving’, or more broadly ‘wellbeing’, in partnership with stakeholders to inform an area of policy. In this case, that area is support of people living with financial hardship in the UK, but the process is portable to other contexts. The novelty of this process is in the combination of qualitative and quantitative methods using a participatory approach.1 Importantly, we apply this combination of approaches to wellbeing as a way of modelling a process that respects different types of stakeholders and their distinctive type of knowledge about wellbeing and brings them into a structured conversation. Wellbeing research especially benefits from the connection between participatory and mixed-methods because wellbeing is a thick multidimensional phenomenon and because standard approaches to wellbeing in economics and psychology do not typically integrate qualitative and quantitative modes of reasoning (Mitchell & Alexandrova, 2021). Our experience shows that wellbeing research can be pluralistic and participatory.
Coproduction, in the sense used here, involves bringing together people with lived experience of how policy affects stakeholders, practitioners who implement the policy, and technical experts with area-specific knowledge to share power, learn from each other, and craft knowledge necessary for sophisticated policy (Alexandrova & Fabian, 2022). In our case, we brought together practitioners from the UK anti-poverty charity Turn2us, people with a lived experience of financial hardship and Turn2us’ services, and academic experts in wellbeing. The joint authorship of this article reflects all these constituencies.
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Coproduction and other forms of citizen involvement are emphasised in perspectives on wellbeing policy emerging from political science (Scott & Bell, 2013), management (Daniels et al., 2018), and sociology (Oman, 2021). Yet practical recommendations for how coproduction of WPP could be done in practice are hard to find, perhaps inevitably so given differences in contexts. We hope our study outlined here can act as a proof of concept for colleagues in the field of wellbeing research, and our methodology as a template for further learning on how to institutionalise and prosecute participatory wellbeing public policy (WPP). We have several papers in this project focusing on a variety of its other dimensions. Fabian et al. (2023) analyses the distinction and complementarities between the sort of bottom-up approach explained here and top-down approaches like WELLBYs2 or national wellbeing frameworks like the New Zealand Living Standards Framework. Alexandrova & Fabian (2021) focuses on more abstract themes of knowledge creation and ethical legitimacy in science and policy. The present article instead provides an exposition of our case study work with Turn2us, including a detailed account of the coproduction process employed and the theory of thriving in which it resulted. Finally, Cinamon-Nair and Fabian (2023) provides a constructively critical reflection on this coproduction work with Turn2us, including an in-depth analysis of issues like reflexivity, power, ‘value-for money’, and the practical, logistical, and administrative challenges of doing coproduction in the United Kingdom.
2 The Need for Context-sensitive Policy
Our project was motivated by numerous literatures converging on the importance of designing policy that is sensitive to the many nuances of its context (Scott & Bell, 2013, Fabian et al. 2022). While such context-sensitivity may seem obvious, it runs counter to several policymaking trends of recent decades. Notably, the tendency in New Public Management to employ a limited number of easily comparable outcome metrics to enable policy evaluation undermines the tailoring of policy to idiosyncratic local issues (Muller, 2018). Scholars of public administration have demonstrated the unintended consequences of such management by benchmarking, in particular the demoralisation of frontline staff who feel unable to promote, say, ‘education’ richly conceived rather than a narrow indicator of it like PISA scores (Van Thiel & Leeuw, 2002). Similarly, literature in the local government and regional development space has long noted that ‘community ideas, energy, social capital, and local knowledge are…key ingredients for solving a range of entrenched problems’ (Eversole, 2011, p. 51). Yet these resources go under-utilised in part because the ways of knowing and forms of evidence common among stakeholder communities are often incompatible with centrally dictated metrics, standards, and objectives. The result is community engagement that makes little sense to those communities and policy that fails to address their needs. A unifying theme of these literatures is that high-level policymaking, with its standardised metrics and one-sit-fits-all approach, fails to effectively identify what goes right and wrong at the policy coalface i.e., where public policy meets a service user. In contrast, context-sensitive approaches begin at the coalface and are thus better equipped to inform policy design and reform.
Context sensitivity is especially relevant for WPP. Most of the academic discourse concerning ‘wellbeing’ and related concepts like thriving and welfare implicitly assumes the existence of what Alexandrova (2017) calls an ‘all-things considered’ conception of wellbeing. This is a conception of wellbeing that holds for all individuals and all contexts; it is in that sense invariable rather than pluralistic (Mitchell & Alexandrova, 2021). However, there does not seem to be any agreement on such a theory. Psychologists tend to see wellbeing as a mental state (Diener & Seligman, 2004), economists as the satisfaction of rational preferences (Angner, 2009), and development practitioners as the ability to translate capabilities into suitable functionings (Alkire, 2005). Against this background of seemingly endless debate, Alexandrova (2017) argues for a ‘contextualist’ approach to wellbeing. This replaces the search for an ‘all things considered’ concept and theory of wellbeing with an array of ‘mid-level’ concepts and theories that are tailored to their particular domain, such as child wellbeing, consumer wellbeing, environmental wellbeing, etc. The ‘context’ for which mid-level theories are developed can be extremely broad, such as when designing wellbeing theories to inform national statistical accounts, or relatively narrow, such as a wellbeing framework for a small rural community.
Mid-level theories have pragmatic appeal for science and policy (Fabian, 2021). What aspects of wellbeing are salient in a given context or relevant to applied work therein are likely to be finer grained that what a general theory can articulate. For example, ‘health’ is an item that many different accounts of wellbeing agree contributes to wellbeing. Yet what health means for someone in palliative care is likely to be markedly different to what it means for a new-born baby. In the former, we might emphasize pain management whereas in the latter we might focus on brain development. A general notion of ‘health’ is of limited usefulness to practitioners in either of these spaces because they need to know how health manifests in their context so that they can tailor their efforts at improving it. This logic applies to measurement as well. A general measure of health, such as life expectancy, is of limited usefulness in palliative care, where a physician could make more use of measures like mental acuity or red blood cell count.
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3 Why Coproduction?
An additional point in favour of mid-level theories is that they make it practically feasible for local stakeholders to define wellbeing and how it should be measured. Wellbeing is what philosophers call a ‘thick concept’ (Anderson, 2002). These types of concepts describe and evaluate. As such, they are both amenable to empirical analysis, which makes them scientifically tractable, and value-laden, which means that their study can never be a value-neutral, purely technical exercise (Alexandrova & Fabian, 2022). Democratic norms require that value judgements in policymaking be made with the involvement of affected stakeholders. This is difficult when developing a general theory of wellbeing to inform policy at a high scale, as in national statistics, both because of the generalisability requirements on the theory and because of the logistical challenges of involving so many stakeholders. In such cases, wide ranging consultations like the UK Office of National Statistics’ ‘What Matters to You’ exercise are appropriate (Oman, 2021). In contrast, it is both theoretically appropriate and logistically more straightforward to involve stakeholders in a thorough coproduction exercise when designing a mid-level theory for a particular policy context. In a sense, national statistics is such a particular context with its own context-sensitive needs. But these needs should not be mistaken for the needs of WPP in general.
Genuinely sharing power with those affected by policy and inviting them to coproduce that policy ensures that their value judgements are centred (Osborne et al. 2016). However, coproduction is not about uncritically accepting the perspectives of people with lived experience. This might seem ethically attractive at face value but places an undue burden on people with lived experience, expecting them to solve complex policy problems with little more than their voice. Lived experience can be best utilised when it is supported by the practical insights of policymakers and the technical expertise of subject matter experts. Two-way learning between these groups can sharpen the insights of people with lived experience and translate them into effective policy. For example, council members coproducing a town rejuvenation plan with local residents can impress upon them the urgency of increasing revenues to fund public services, and technical experts can help estimate how much revenue might result from each rejuvenation option. This approach of blending lived, practical, and technical expertise achieves both the ethical imperative of centring people affected by policy and the epistemic objective of learning how policy could be better (Fung, 2015). Unlike consultations or some deliberative mechanisms, coproduction makes experts and policymakers active learning participants, instead of merely sitting outside the process and soliciting value judgements from stakeholders (Setälä, 2017).
Coproduction and deliberative democratic mechanisms are increasingly employed in a range of policy settings to involve stakeholders in making value judgements (Daniels et al., 2018; Degeling et al., 2015). For example, the UK’s National Institute of Health Care Excellence (NICE) established a ‘citizen’s council’ in the early 2000s to capture the views of the public in shaping the Institute’s value judgements (Rawlins, 2005). In the wellbeing policy space, practitioners in the capabilities tradition, healthcare, and service provision have long utilised coproduction and participatory methods to understand what aspects of wellbeing matter to indigenous groups, people in poverty, and other stakeholders. These exercises have informed the development of surveys that track wellbeing over time as defined by the communities in question (see Sollis et al., 2022 for a systematic review). We were inspired by these methods in our work with the national anti-poverty charity Turn2us, who sought to coproduce a theory of ‘thriving’ to inform their work with people living in financial hardship.
4 Turn2us
Turn2us is a national charity in the UK that provides practical information and support to people who are struggling with money. The charity works alongside those who have experienced not having enough money to live on to develop schemes that help people cope with life changing events such as job loss, illness, or bereavement. The Turn2us website (www.turn2us.org.uk) includes a ‘Benefits Calculator’ where individuals and households can find out what welfare benefits and tax credits they are entitled to, a grants search to find out if they might be eligible for support from over 1500 charitable funds, and a range of information and resources to help people struggling to get by, including a helpline and live chat service that receives around 100 000 calls per annum. Turn2us also provide direct financial assistance through grants. These come from the Elizabeth Finn Fund, which supports people from over 120 different professions, and the Turn2us Response Fund, which supports people when they have had a life-changing event in the last 12 months that has left them in financial hardship. The audience for the grants is typically quite different from the audience for the helpline, benefits calculator, and information programs.
The exercise described in this article is an outcome of two commitments by Turn2us: the centrality of coproduction to most of their activities3 and a desire to embed a positive ideal of thriving into their efforts at poverty relief. Putting these two together, Turn2us invited Authors 1 and 2’s participation as technical experts in ‘wellbeing’. Thriving is broad notion that, in the psychological literature, typically includes a variety of kinds of wellbeing, hedonicand, eudaimonic, and other (Su et al. 2014). However Turn2us was seeking a concept of thriving adapted to their context of serving people who struggle financially. To use the language of Sect. 2, they looked for a mid-level theory of thriving. The next step was to devise a process that does justice to the wealth of scholarly knowledge about wellbeing, as well as to the specific circumstances of Turn2us and their stakeholders.
5 Our Coproduction Process
Our process for coproducing a theory of thriving was designed to generate data and feedback in a way that balances two competing needs. The first need is for the sort of rich, qualitative data and discussions that can inform a theory of thriving for people living in financial hardship, which is a complex and nuanced experience. For such a theory to be coproduced requires an intimate setting that facilitates genuine power sharing, in-depth dialogue, reflexivity, and two-way learning (Clark et al., 2019). The second need is for quantitative data and feedback that ensures some degree of representativeness. Turn2us is a national charity with a diverse base of service users. It cannot accept a theory of thriving that disproportionately reflects the experience of a narrow subset of these individuals, which is a risk with qualitative methods and intimate settings. To this end, our methodology combined a core of qualitative data collection in an intimate setting with quantitative surveys at the beginning and end of the process. It comprised five stages, outlined below.
5.1 Stage 1: Survey
We began by analysing survey responses from 1571 people who have previously or currently used Turn2us’ services. We sourced these responses using Turn2us’ monthly newsletter, which reaches around 5000 former or current service users. This online survey (see appendix 1 for all questions and summary statistics) consisted of demographic questions plus six questions concerning how service users conceived of the notion of thriving. Four of these were ranked-choice questions, such as:
Please rank the following items in terms of how much they resonate with what thriving means to you (leave blank any that do not resonate):
a)
Being in a positive mental state (good moods, satisfaction with life, happy, etc.)
b)
Being able to satisfy your desires and preferences.
c)
Having income, health, education, and political rights.
d)
Being free to decide for yourself how you want to live your life, feeling effective in your life, and having supportive social connections.
e)
Being able to develop and express your unique personality.
These ranked-choice questions were designed to assess the extent to which prominent theories of wellbeing from the academic literature mapped on to service users conceptualisations of thriving. For example, in the question above, (a) corresponds to mental state accounts of wellbeing like subjective wellbeing (Sumner, 1996; Frijters & Krekel, 2021), (b) to preference satisfaction theories common in economics (Hausman, 2015), (c) to the capabilities approach (Robeyns, 2017), (d) to the three basic psychological needs of self-determination theory, one of the more prominent psychological accounts of ‘eudaimonic’ wellbeing (Ryan & Deci, 2017), and I to nature fulfilment theories of wellbeing, which are common among philosophical accounts of eudaimonia (Haybron, 2008; Besser-Jones, 2014).
The two remaining wellbeing questions solicited open ended responses. They were:
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What is the single biggest obstacle to your thriving?
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Is there anything that you feel your friends, family, colleagues, community, social workers or the government misunderstand about what would help you thrive?
The objective of this survey was to get an initial steer for the qualitative portion of the coproduction process. We wanted to ensure that we discussed issues that were of interests to the broad spectrum of Turn2us service users, and that we didn’t start off in the wrong direction. We presented findings from the survey in the first meeting of the working group using charts and word clouds (see Appendix 1). Some key takeaways were as follows:
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Individuals emphasised mental states, capabilities, and basic psychological needs. Personal expressiveness and preference-satisfaction did not resonate.
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However, being in a good mood was of low importance. Instead, respondents prioritised a sense of meaning and purpose, freedom from anxiety, and overall life satisfaction, in that order.
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Respondents emphasised satisfaction with family life, health, and financial situation, in that order, and put little emphasis on satisfaction with community and job.
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The most prominent terms associated with obstacles to thriving were worry, pay, basic needs, others, job, and financial.
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The most prominent terms associated with misunderstandings of thriving were lack, work, job, debt, COVID, education, people, stress, and fear.
5.2 Stage 2: Working Group
The ‘working group’ consisted of representatives from the three ‘expert’ groups that we had identified: four people with lived experience, three academics, and five practitioners from Turn2us (more detail on selection criteria and representativeness below). Following the practices of Turn2us4, we use the term ‘lived experts’ for people in the first group who have first-hand experience of living in poverty and under financial stress. All lived experts involved at any stage of the coproduction process were paid the London Living Wage (£11/hour) for their time, including for reading and administrative tasks. The primary activity of the working group was for members to interview each other one on one to gain an interpersonal understanding of what thriving means to people experiencing financial hardship, what the practical needs Turn2us had from a theory of thriving, and in what ways existing thinking about wellbeing and its measurement could inform the theory of thriving we aimed to produce. These interviews formed the principal source of qualitative data for the project and underwrote discussions of thriving in all-participant working group meetings that further informed the theory. The result of the working group process was a ‘preliminary report’ that was then taken into stage 3.
5.3 Stage 3: Half Day Workshop
We invited an additional 10 individuals with lived experience of financial hardship to a half-day event in which they could offer their thoughts on the preliminary report and deliberate with working group members on how it could be refined. This injected greater representativeness into the qualitative side of the project without logistically overburdening it. The event was inspired by consensus conferences from the deliberative democracy tradition (Anderson & Jæger, 1999). Members of the working group with lived experience took the lead in facilitating the workshop to support their ownership of the project, with administrative and logistical support provided by other working group members (see Appendix 2 for the support material). The 10 new participants would be selected primarily from demographics that were not represented in the working group, such as members of the LGBTQ community and recent migrants. The comments of new participants were used to refine the model ahead of a final report. If their comments had been overwhelmingly negative we would have restarted the working group process. Workshop participants were surveyed before and after the event to gauge their satisfaction with the event and the report and to assess whether their participation in the deliberations had altered their views. The full results, which were overwhelming positive, are reported in Appendix 1.
5.4 Stage 4: Final Report
The preliminary report was refined on the basis of the workshop deliberations. A final report was then officially launched by Turn2us with an associated publicity run and outreach activity (Turn2us 2021). Participants in the working group and workshop were invited to the launch events, including a seminar on the process and its results.
5.5 Stage 5: Feedback Survey
To check for representativeness, we bookended the process with another survey of Turn2us users through the charity’s newsletter. The objective here was to check for agreement with the report, and if that was lacking, to understand what needed improvement. We asked three questions:
1.
(1–5 scale) To what extent do you agree that the report reflects your thoughts and experiences about ‘thriving’?
2.
(1–5 scale) To what extent do you agree that our process of coproduction has succeeded in ensuring the reports reflects the diverse perspectives of people with lived experience?
3.
What, if anything, do you think is missing from the report?
We provided an illustrated short (6 min) video explainer of the report on the Turn2us website where it was published to make it more accessible. Nonetheless, given that answering this survey required engagement with complex material, response rates were understandably much lower than for the first survey – only 17 responses, in fact. However, the report was broadly well received by these committed respondents (see Appendix 3). Average scores for the first and second questions were 4.06 and 4.18, respectively, and the most common answer to question 3 was ‘nothing’. In future exercises, we will ponder ways to reduce the burden on people who would like to engage with and comment on the report, such as shorter summaries.
The model of thriving embedded in the report is now being implemented in an organic way across Turn2us’ operations. As this process matures, we hope to identify ways to refine the model, and also identify applications of it that lend themselves to measurement of thriving. Once we can observe the practical requirements of measurement in greater detail, we will likely commence a second coproduction effort to develop and validate these measures.
6 Selection of Lived Experts & Practitioners
Selecting people with lived experience for our coproduction exercise was a delicate balancing act handled largely by Turn2us’ coproduction lead Abby Meadows. Lived experts needed to have personal experience of living with financial hardship and some sensitivity to the experiences of other people in similar circumstances. Ideally, they also needed experience of engaging with Turn2us or a similar charity. Due to the conditions of the original endowment Turn2us administers, the charity works overwhelmingly with people from ‘professional’ backgrounds. These include service sector workers, like nurses, lawyers, and bureaucrats, as well as people with trades, such as plumbers or beauticians. As such, our lived experts also needed to have such backgrounds. Participants needed to be up for the intellectual challenge of the task, possess the time and flexibility to participate, and have the temperament to be an effective collaborator. Finally, we tried to ensure a wide variety of demographics were represented. Recruitment was done by emailing the Turn2us’ roster of people interested in coproduction. Individuals are added to this as they come into the charity’s orbit and potentially removed if they participate unconstructively in coproduction, such as by being dismissive or domineering.
Lived experts in the working group aged from late 30s to late 60s, 2 men and 2 women, 3 white and 1 black, with and without children, and with experiences of racism, disability, domestic violence, homelessness, and mental health issues. One lived expert was a semi-retired social worker caring full time for her mother, another a community worker, another was a disability rights campaigner, and the last is involved in campaigning for socially excluded people, particularly the homeless, around London. Workshop participants broadened this group considerably. We brought in several young people aged 19–35, lived experts from across the geography of the UK, both rural and urban, people of varied sexualities and genders, including two individuals identifying as transgender, more people of colour, more parents, an autistic person, and people who had migrated to the UK in the past 5 years. New lived experts also had a diverse range of occupational backgrounds.
7 Qualitative Methodology
We adopted a mixed-method and mixed-methodology approach to facilitate our needs for two-way learning and genuine power sharing, a balance of representativeness and conceptual saturation, and highly iterative process. We have already discussed our quantitative surveys, so in this section we restrict the discussion to our qualitative analysis.
Data generation.
Our emphasis on power sharing and two-way learning was grounded in the paradigm of participatory action research (PAR), which also informs Turn2us’ coproduction methods. PAR finds its intellectual roots in the Marxist-inspired works of Lewin (1946) and Friere (1970) and is normally employed to help communities problematise their situations, raise consciousness of their oppression, and provoke political action. While this can often be valuable, we wanted to avoid embedding an explicit political agenda in our work from the outset. While some degree of normativity is impossible to avoid in participatory work, especially with value-laden terms and policy implications, we wanted ours to be first and foremost an epistemological exercise. We certainly did not want to begin from the political propositions of Marxism, or any other prominent ideology other than perhaps anti-technocracy, as some of our coproduction partners may not share them. What we took from PAR was its research methodology. Minkler (2000, p. 192) lists the following key features:
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PAR emphasis systematic investigation with “the active involvement of the people whose lives are affected by the issue under study”.
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PAR approaches “consciously blur the lines between the researcher and the researched” to achieve a “cooperative, co-learning process”.
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PAR uses “democratic participatory approaches and social learning”.
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PAR is an empowering process by which participants can increase control over their lives by nurturing community strengths and problem-solving abilities.
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PAR is driven by community priorities, rather than those of outside experts.
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PAR is a “ground up rather than top down approach” that emerges “out of a recognition of the limitations of expert knowledge and narrow single-discipline approaches to complex human problems”.
To embed these principles in our data gathering approach, we used Fujii’s (2017) technique of ‘relational interviewing’ within the working group. Fujii emphasises the following features of relational interviewing, which overlap substantially with the concerns of PAR:
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Ensure that power is genuinely shared between researcher and researched, and that dialogue runs in both directions.
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Build a working relationship with interviewees that goes beyond ‘rapport’.
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A culture and atmosphere of respect, dignity, and humanist values is crucial to ensure that people can be open the sensitive topics in question.
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Respect different ways of knowing. People’s wisdom comes from a variety of sources, such as personal experience, book learning, and learning by doing, and some work might need to be done to translate this wisdom such that it can be understood by others.
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The interview should be ‘teller-focused’ i.e. learning from the person with the relevant experience, whatever it is that they think is relevant to tell.
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Reflexivity of all parties is crucial: participants must be aware of how their characteristics and behaviour impact the conversations had and the data that emerges.
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Interviews should be based on some semi-structured questions, but active listening is more important. For two-way learning to take place, parties to the conversation must be able to respond to emotional cues and inhabit each other’s perspectives.
What we wanted was a way of thinking about the structure of interviews, both in terms of their questions and manner, that emphasised that both sides were ‘the researcher’ and ‘the subject’, that both sides thus had equal power and a desire to learn from each other, and that the direction and progress of the interview should respond to the whims, intuitions, and needs of all parties. In practice, however, we found that our coproduction partners were eager to receive (rather than generate) lists of semi-structured questions and tended not to venture much beyond these. Interviews also typically, perhaps due to nervousness, fell into the form of one party taking on the role of interviewer and working through the question list, then swapping rolls with their partner. There were few follow-up questions posed and the semi-structured questions rarely turned into launch pads for wider ranging discussions. Nonetheless, in feedback and in discussions at regular working group meetings, coproduction partners were emphatic that they felt able to get their points across, felt respected and heard, and did not feel constrained by the sample questions provided. Indeed, they found the suggested questions very helpful for ensuring their interviews generated useful insights.
The workshop employed straightforward focus-group style methods. We took a pre-workshop survey of new coproduction partners (see supplementary data file 1) that gave them space for open-ended responses to the question of “what is missing from the model?”. The break-out rooms provided interview notes. One workshop participant did not want sessions recorded so we could not take full transcriptions. The plenary sessions then provided further notes as well as image-captures of the ‘jam boards’ (a digital board of post-it notes) that we used to share insights from the various break out rooms.
The time constraints facing the workshop made the power sharing ideals of our approach more difficult to implement than in the working group process. The priority for the workshop was to get input from the new coproduction partners, both as a fresh set of eyes and as representatives of demographics that were not present in the working group. To get this input efficiently in the time available, we felt it was necessary to have members of the working group adopting an ‘interviewer’ role. There was limited two-way learning beyond the initial presentation and explanation of the working group’s preliminary report, though we did have several rounds of Q&A. We hoped that putting lived experts in charge of the breakout rooms would emphasise that we wanted them to have ownership of the project and its outputs. In addition, we tried to empower the new coproduction partners by asking working group members to take a strong and explicit stance in favour of listening respectfully to input rather than commentating. Finally, we mailed out a ‘You said, we did’ document to workshop participants once the report was updated outlining how we had amended it in-line with their comments. This is standard practice at Turn2us and upholds our commitment to coproduction and centring lived experts.
Feedback on the workshop process, provided in supplementary data file 2, suggests that participants were broadly satisfied with the experience. Participants gave an average response of 95, on a 1–100 scale, to the question “To what extent were your thoughts, feelings, and perspectives on thriving taken into consideration by the group?”. They gave an average response of 90 to the question: “Did the workshop give everyone the opportunity to share their views and incorporate them into the model of thriving?”.
7.1 Data Analysis
Two analysts (authors 1 and 3) conducted the qualitative analysis of the interviews. Note that these researchers were participants in the interviews and thus coded each other’s interviews. This provides some rigor in two regards. First, it means that one analyst can cut through theoretical biases the other brought to their interview practice at the coding stage. Second, it means that in coding interview transcripts the analysts are not simply coding their own words.
The analysts began by using grounded theory (Charmaz, 2006), which is the simple idea that theories based on qualitative research should be ‘grounded’ in the associated data. In practice, grounded theory involves using ‘descriptive’ codes to label what is literally said in interviews, returning to earlier data sources iteratively as new codes emerge. A second round of ‘analytical’ codes is then used to organise the descriptive codes into clusters, themes, and ultimately theories.
Descriptive codes varied from line-by-line to paragraph-by-paragraph. The analysts discussed whether they were approaching this exercise similarly in terms of label variety/specificity and text-length, but otherwise did not discuss the actual codes they were using to avoid influencing each other’s analysis. After coding around half the material (i.e. around 20/39 interviews), both analysts started again from the beginning to reanalyse early interviews with codes that had emerged later in the process. At completion, the analysts compared codebooks and were pleased to discover that their codes were broadly similar. To evidence this, Table 1 shows the top 7 codes across each analyst.
Table 1
Seven most common descriptive codes
ANALYST 1 | ANALYST 2 | ||
|---|---|---|---|
Freedom and autonomy | 11 | Beyond Money | 13 |
People are different | 11 | Self-realisation | 7 |
Self-expression and self-knowledge | 10 | Thriving changes over time | 6 |
Family | 10 | Thriving as family support | 6 |
Cultural expectations | 10 | Basic needs met | 4 |
Thriving is more than material | 10 | Beyond the American dream | 4 |
Financial security | 9 | Thriving as independence | 4 |
The next step in the qualitative analysis was to make sense of the descriptive codes in a way that would produce a model or theory of thriving. At this stage, the analysts adopted divergent strategies to try to address their own biases, check whether different methods yielded different results, and increase the likelihood that we achieved conceptual saturation and organised themes in a neat way. Analyst 1 has a substantial background in wellbeing theory. This allowed him to utilise a theoretical coding approach, applying existing ideas from the interdisciplinary wellbeing literature to organise the descriptive codes into a coherent system. In contrast, analyst 2 had no background in wellbeing studies but experience with qualitative research methods. This allowed her to use the more inductive approach of thematic analysis (Braun & Clark, 2006). This involves organising descriptive codes into themes that make ‘sense’, from the analyst’s point of view, of those codes. Both analysts ended up with similar clusters of themes, though analyst 1’s model is noticeably more inspired by existing ideas in wellbeing scholarship.
Analyst 2 listed the following 7 themes as organising what thriving meant to working groups members (reproduced verbatim from notes at the time):
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Physical and mental health, including access to services and being on a positive trajectory.
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Freedom to pursue authentic desires: a combination of what you’re good at and what you deem meaningful.
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Capabilities: free from financial insecurity, physical or emotional harm, the disabling society (Oliver, 2012), etc.
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Beyond materialism: rejection of the American Dream/Rat race.
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Sense of purpose: volunteering, caring, progression, qualifications.
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Rising consciousness: awareness/questioning of structural injustices.
These themes were well-received by the working group when presented at its first interim meeting. Lived experts commented that the themes resonated well with their thoughts, feelings, and experiences regarding thriving. Each of these themes features in Analyst 1’s model, which evolved into the model incorporated into the final report.
Our strategy for integrating the quantitative and qualitative should now be clear. The quantitative data came from the surveys that opened the coproduction process at Stage 1 and closed it at Stage 5. There was also arguably quantitative knowledge of existing scales of subjective wellbeing and their psychometric properties supplied by Authors 1 and 2 due to their fluency in wellbeing science. In each case, this knowledge guided the coproduction process by providing signposts that could not be ignored. But whatever the stage and whatever the source, quantitative data never dominated the process. Quantitative results were always interpreted in the light of relevant theoretical or qualitative input.
8 Example of Contextualised Wellbeing: A Theory of Thriving for Turn2us
The working group, seminars within Turn2us, and the workshop process eventually led to the three-part model depicted in Fig. 1, which we refer to as ‘the tree model’ owing to its central metaphor. The three parts are means, process, and outcomes.
8.1 Means
Your means are the resources that allow you to be who you want to be and do what you want to do. These means vary from person to person and change over time, but we all have basic needs like food and medicine. If our basic needs are not secure then we cannot thrive: “Because if I didn’t have a roof over my head, I can’t even think about any other thing. If I cannot feed myself or my children. I cannot think about studying. So that has to happen first” (Gladys). In our discussions, two types of means in particular stood out: practical means, and justice-focused means. Practical means are specific to you. If your knee hurts when you go for a walk, for example, your thriving will be held back. Justice focused means are about whether social, political, and economic conditions are conducive to thriving. If people frequently disrespect you just because you’re black, for example, it will hurt your thriving. Or if society and culture are structured to overlook your cognitive ability because of your physical impairment (Oliver, 2012):
As a disabled person, just like anybody else I have dreams and aspirations about where to go in my life, and as well as many other people, many of those dreams are not fulfilled. And some of that is related to disability because it is quite difficult to work your way up in the world of business as a disabled person…When I left University with a master’s degree, and after my bachelor’s degree, and I was looking for work, I was told, because I didn’t get any job interviews…answer telephones.– Rudi
In the context of Turn2us’ work, coproduction partners put an especial emphasis on the following practical means:
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Financial security, including housing and bills.
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Health, both physical and mental.
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Advocates and allies.
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Access to the welfare and legal system.
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Support from friends, family, and the community, and being able to ask for it.
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Education and skills,
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Time to think and plan.
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Resilience and coping skills.
Our discussions of justice focused on.
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Freedom from racism, sexism, classism, domestic violence and oppression.
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Overcoming marginalisation and stigma from disability and unemployment.
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Challenging cultural expectations, like heterosexuality or materialism.
We see here a direct illustration of the point made earlier that abstract wellbeing items like freedom need to be specified in more detail to be useful to a specific context. For example, lived experts outlined particular things that curtailed their freedom, such disapproval of their black partners or the lack of disability access to shops. While some of the items emphasised by our coproduction partners are common to coproduction efforts in other contexts, such as financial security, health, and freedom, some appear specific to the context of Turn2us work, notably advocates, access, time, and overcoming the stigma of unemployment.
Fig. 1
The tree model of thriving
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8.2 Process
With the means in place, the individual can start exploring who they are and this is what we label as ‘process’. Two frequent themes of our discussions were that thriving is more than material and that it is subjective and different for each person. Having your basic needs met is the most important thing for thriving, but you also need to discover what thriving means for you individually. What job would you enjoy? Is there a neighbourhood you love living in? Where can you find good friends? What sort of life would best suit you? This theme was particularly stark in the experiences of one of our coproduction partners, who only discovered his intrinsic motivation for art (and from there to acting and video production) after being able to dabble in it while staying in a homeless shelter. He had previously been unfulfilled in his otherwise ‘successful’ life as a sales executive:
I wanted to be a big shot businessman, you know, sales director of the biggest multinational in the world…and I never thought I had a creative side. But in the last five year’, I’ve pretty much become a painter, I’ve done loads of acting – commercials and a few other, music videos, and whatever…An’ it’s everywhere in society. So much untapped talent, but there’s no resources, and opportunity for people to have the freedom to kind of explore these things that they’ve got, and so they don’t know that they’ve got necessarily – James.
Our research found that you might initially use your means on things that don’t suit you, perhaps because of cultural expectations or family pressure. But if you have the time, money, support, and freedom to keep experimenting, you’ll find your way. For example, one of our lived experts was unable to see past cultural expectations around family and marriage to break away from her abusive marriage, but she only started thriving once she set out on her own:
I would say thriving is a subjective feeling, because if I had gone with my previous definition of thriving, I think that was like a social construct – what society thinks: you should be in a place [home], you should be married etc… So my current thriving, as a single mother, is not seen as an ideal; it’s being frowned on. But it’s my subjective feeling. I am happy within myself. Yesterday, I was having a discussion with one of my classmates and he was feeling sorry for me: “Oh, I know it must have been really difficult for you”. I said: “well, it is but don’t feel sorry for me because I am in a better place now. I feel much happier than where I was before”. So yeah, I would say it is subjective…. What I feel within myself not what someone will tell me. – Gladys.
The notion of ‘process’ that emerged in our research is similar to the notion of ‘self-actualisation’, a frequent theme in the humanistic psychotherapy tradition.
8.3 Outcomes
Our coproduction partners identified a range of indicators of thriving that let you know that you’ve found the activities and values that suit you. The most important outcome was strong relationships that are mutually supportive and enriching. We are more likely to build these when we’re around people who share our values:
I guess, for me, and you mentioned as well, then I see like the word “community” or something that encapsulates being part of something; that’s been really important to me in relation to thriving. – James.
Lived experts placed a strong emphasis on a sense of autonomous and being in charge of our life. These arose when they could invest their time, energy, and resources as they wanted, and were free from oppression:
The times in my life when I was thriving is when I finally made the decision to leave my marriage… going through what I went through, my marriage, and after I got to the position of leaving it, I got clear insight now that actually this is me now. I’m actually thriving, being on my own, standing on my feet, and saying no to putting up with domestic abuse, and being independent really, and being happy. – Gladys.
We get a sense of competence was also a common outcome associated with thriving. This occurs when we improve our skills and achieve our goals:
But the thriving part of that was when, an’ it’s going to sound terribly cliche but you have to see it from the perspective of being spinal injured, driving along San Francisco Bay, with my new[…] girlfriend sitting next to me, and feeling really rather magnificent and then my disability didn’t seem to be there anymore, because I was sitting in a regular car driving along a regular road with a regular person sitting next to me. – Rudi.
Autonomy, competence, and relatedness are the three basic psychological needs emphasised by self-determination theory (Ryan & Deci, 2017), a prominent account of wellbeing in social and clinical psychology. Self-determination theory has also emphasised the importance of ‘self-concordant’ values and behaviours. It thus fits some of the themes of our qualitative data. However, it does not speak to the strong theme of basic needs, nor justice. Furthermore, there were other outcomes associated with thriving that feature in only a limited way at most in self-determination theory. The first of these is a sense of purpose: that what we’re doing is important and, commonly, helping other people:
So, thriving is partly my job, but looking after my mom I was thriving, I felt it wasn’t, I didn’t have money, and it was difficult, but I found I was thriving because I was doing something where that was, you know, was enriching to me. – Toni.
The second was feeling content and at peace with ourselves, which emerges when our means are secure and we can do the things that suit us we feel.
Strikingly, the lived experts spoke very little of pleasure or life satisfaction. Even happiness barely featured. There was one participant at the workshop who found the day-to-day suggestions offered by Action for Happiness helpful in improving their mood during COVID-19 lockdown, and they said that this contributed to their thriving. More broadly though, there was a sense that lived experience with financial hardship and other difficulties made one resilient to issues around mood, which were seen as sort of trivial in the circumstances. Mental health was certainly a strong theme, but again less in terms of bad moods and more in terms of long periods of depression and debilitating anxiety. Recovering from mental illness was seen in terms of autonomy and being at peace with oneself, not in terms of being happy. Broadly speaking, thriving was about transcending one’s circumstances.
8.4 The Tree Metaphor
In all-member meetings of the working group, we discussed several ways of using metaphors or models to represent the dynamics and interrelationships between the different components of thriving identified in our qualitative analysis. Such an overarching framework was considered important for accessibly communicating the overall picture of thriving in financial hardship. This was a challenging process, but we eventually settled on the tree metaphor. The means can be represented with the basic requirements for a healthy tree: roots (material needs) and soil quality (justice). The process is the trunk and branches of the tree—we grow in our own unique ways to take the shape we want. And the outcomes are the leaves and flowers, which let us know that a tree is really thriving. The tree metaphor helps us apply the model of thriving. If someone has financial security but they’re held back by oppression, then it is social justice they need. If they’ve found their calling but they’re still struggling to flourish, then they they likely lack the practical means to achieve their goals. The tree metaphor also reflects that thriving is different for each of us and changes over time. We need to be sensitive to how people are growing and help them adapt to shocks like unemployment just as a tree needs time to adapt to losing a branch. The tree can also handle cases like dying at the end of a life well lived. This is a case of the roots dying out on a big, beautiful, old tree. We can see that this tree has thrived, but its time is coming to an end.
9 Measurement
While academic theories of wellbeing were well received by coproduction participants and are clearly reflected in our theory of thriving, the same cannot be said for measures of wellbeing. Most prominent scientific approaches to the measurement of wellbeing were rejected by participants for one reason for another. Capabilities and surveys were considered too long. Both lived experts and practitioners stressed that people seeking support from Turn2us were in a desperate situation and would be turned off if required to answer many pre-packaged questions before receiving assistance. This problem applied to psychometric surveys as well, such as the 15-item wellbeing profile (Marsh et al., 2020): service users were already expected to answer a host of questions pertaining to their financial and personal situation when applying to Turn2us, and the charity did not want to add a double burden. Both capabilities and psychometric surveys were also seen to miss important aspects of thriving in the case of Turn2us service users. In the first case, the process by which authentic values are discovered. In the second, the basic means necessary to allow for exploration.
Turn2us had previously tried to use life satisfaction scales but found them insufficiently sensitive to the treatment period. An additional difficulty is that lived experts explicitly raised the problem of adaptive preferences (Sen, 1999). This is where an individual grows accustomed to their condition, either though acclimatisation or false consciousness, and thus does not appreciate that their life could be much better. They consequently report high life satisfaction, but after a structural break they look back and recognise that their life was not good. For example, one coproduction partner spoke of how she would have said she was satisfied when she was living with an abusive husband. It was only after a prolonged period of consciousness raising and subsequent divorce that she realised her assessment was biased.
The peculiar measurement needs of Turn2us raise the issue of generalisability. How useful is coproduction to WPP if it always results in idiosyncratic metrics? These are difficult if not impossible to standardise and militate against the comparison of different policies for improving wellbeing. While acknowledging this concern, we think it is overwrought. While coproduction in the capabilities space has thrown up many items unique to particular contexts, many items are shared across contexts. These include obvious items like health and income, but also more nuanced issues like relationships, autonomy, respect, and access to community infrastructure. These shared items can often be effectively measured using standardised instruments. It is thus feasible to develop cross-contextual measures while preserving the need for local theories and measures of wellbeing. Obviously this isn’t good enough for some nodes of policymaking like national statistics, but it is perfectly viable in others, notably local governance.
Turn2us needs time to observe where the theory lends itself to application. We intend to continue working together over the next year to observe this evolution and return to the issue of measurement in the future. At present, one of the more promising metrics is a question like: ‘to what extent do you agree that you have the time, space, and resources to plan for the future?’ This single item captures whether the charity’s intervention has stabilised people to the point where they have the means to embark on the process of thriving.
10 Scaling up and Generalisability
Our methodology has implications for the WPP agenda (Fabian et al., 2023). Advocates would like to see national statistics and policy evaluation broadened ‘beyond GDP’ to consider items like health, inequality, sustainability, life satisfaction, and work-life balance. This is a welcome shift, but as Fabian et al. (2023) argue, WPP could be more transformative than a simple adjustment in headline indicators of progress. If there is a genuine desire to promote ‘what really matters to people’, as advocates of WPP often argue, then wellbeing policy must be grounded in a thoroughly participatory model of policymaking. The process we describe in this article provides a template for the ‘bottom-up’ component of this sort of WPP.
A bottom-up approach differs from the top-down one because it empowers the end-users of governments services and the lowest levels of policymaking, such as communities and local governments, to determine what wellbeing means and how it should be assessed in relatively narrow contexts, like homelessness or national parks. These contextualised wellbeing policies are fed back to the centre through a process of scaling up and generalisation. As adjacent nodes of policy all produce wellbeing policy, they can come together in further rounds of coproduction to develop relatively more abstract conceptualisations and measures of wellbeing that work across all of their contexts. For example, Turn2us intends to collaborate with other charities working with individuals in financial hardship, such as those dealing with debt, housing, mental health, and substance abuse, to develop a theory of thriving that could inform the sector more broadly. This conceptualisation, being at a higher scale of resolution, will necessarily be more abstract the fine-grained conceptualisation developed for Turn2us. But it will also help the sector articulate a shared vision. The same is true for whatever measures emerge. This is in contrast to a top-down approach where standardised, cross-contextual metrics are developed at central agencies, notably treasuries and finance ministries, and used to evaluate policy from a wide range of contexts.
This optimistic view should not be mistaken for naivety. Coproduction is difficult and easily derailed by arrogant experts, intransigent professionals, overbearing lived experts, and a host of other challenges from logistics to dropouts (Oliver et al., 2019). We were quite lucky in our project, and certainly benefitted from Turn2us’ experience using coproduction in their operations. Efforts to build WPP or similar endeavours from the bottom up using coproduction should be mindful of the likelihood of mistakes and the need to learn from them.
There are also debates to be had about what constitutes ‘coproduction’ as distinct from consultation or codesign. Some scholars have high threshold for coproduction that requires people with lived experience to be involved in, among other things, the design of the coproduction process itself, the coding of qualitative data, and the implementation of findings. In practice, this will often be prohibitively expensive, time consuming, and administratively challenging. Our project does not meet this standard, yet we still regard it as coproduction because it is meaningfully more participatory than something like the ONS ‘What matters to you’ exercise, which we regard as an exemplary consultation. From our perspective as academic participants, decision making power really did lie with the coproduction partners, even as they actively resisted taking on the work of project management, coding, and other core activities. We felt, in a sense, like the research assistants of the coproduction partners. A longer discussion of these issues is outside the scope of this article but is undertaken in Cinamon Nair and Fabian (2023).
11 Conclusions
Our experience demonstrates that coproducing theories and measures of value-laden concepts is feasible and fruitful in organisational settings. For researchers in the field of happiness and wellbeing studies, our message is that coproducing theories and concepts with mixed participatory methods is viable. The theory of thriving that emerged from our coproduction exercise does not map neatly onto any ‘off-the-shelf’ academic theories, and such measures were also found to be inappropriate. Genuine power sharing and openness to two-way learning can thus lead to richer and more practical conceptualisations and measures of value-laden concepts than academics, practitioners, or individuals working alone. It can also trigger personal growth for participants. For example, author 1 found the experience transformative for his understanding of disability, practitioners from Turn2us learned how to make their public-facing documents less linguistically ‘middle class’, and lived experts were able to use theories and other inputs from academics to articulate their thoughts and feelings about thriving. The experience was quite meaningful for all parties, exemplified by a poem one lived expert wrote at the conclusion of the project (see Appendix 4). This poem was included in the final report on the project from Turn2us, and underlines that coproduction has the power to bring about wholehearted participation in policymaking.
Acknowledgements
The authors would like to thank participants at seminars organised by the Human Development and Capabilities Association (HDCA), the Cambridge festival, Cambridge Citizen Science Group, the What Works Centre Wellbeing and its Advisory group members, the Bennett Institute for Public Policy, the university of Helsinki Philosophy of Science group, the “Global Medical Humanities: Exploring the Milieu” conference at Cambridge University, the Durham University philosophy of science seminar, the Cambridge University “The Public Cost of Personal Hardship” conference, the BSA Happiness Study Group, and 3 anonymous reviewers for helpful comments, suggestions, and criticisms.
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